Feasibility of Indocyanine Green Fluorescent Cholangiography Via Inguinal Nodal Injection Approach in Upper Gastrointestinal Oncological Surgeries. A Pilot Study.

Fluorescent cholangiography (FC) with indocyanine green (ICG) is an alternative to intraoperative cholangiography (IOC) for visualizing the biliary tract during surgery. This pilot study assessed the feasibility of ICG-FC using inguinal nodal injection in patients undergoing upper gastrointestinal cancer surgery. Under sonographic guidance, ICG was injected into inguinal nodes bilaterally (each side 2.

Indocyanine green and methylene blue dye guided sentinel lymph node biopsy in patients with penile cancer (PeCa): results of 50 inguinal basins assessed at a single institution in India.

Aim: The primary aim of this study was to validate the reliability, sensitivity and safety profile of novel combination of ICG- methylene blue dye as an SN tracer for PeCa.

Methods: This is a validation and non-randomised prospective observational study involving 25 patients (50 inguinal basins) who underwent SLNB where in ICG and methylene blue were used for localisation. The patients with clinically node negative groins were recruited in the study.

Successful Salvage of Partial Gastric Conduit Necrosis by Primary Anastomosis in a Post-Esophagectomy Patient.

Gastric conduit necrosis is a rare but severe complication of esophageal surgery, often associated with mediastinal sepsis and high morbidity and mortality rates, as well as reduced efficacy of conservative treatments. In most cases, management involves salvage therapy, including fluid resuscitation, antibiotics, aggressive debridement, drainage of infected collections, and proximal esophageal diversion. Primary anastomosis is rarely performed.

Grossing to reporting of Wilms tumor with emphasis on proper sampling in treatment-naive and postchemotherapy specimens and their clinicopathological correlation with outcome.

Context: Emphasis on grossing to reporting for the assessment of histopathological parameters predicting outcomes in Wilms tumor.

Aims: To analyze various clinicopathological parameters that effect outcomes in treatment naïve and post chemotherapy Wilms tumor specimens.

Settings And Design: This was a retrospective observational study.

Management of Epirubicin Extravasation Injuries of the Hand with Debridement and Flap Cover-A Case Series.

Chemotherapy extravasation injury is an iatrogenic injury due to extravasation of the drug from the vessel during infusion therapy. Among various chemotherapeutic drugs, DNA binding vesicants like epirubicin and doxorubicin can lead to extensive tissue necrosis following extravasation. They are commonly used in many chemotherapy regimens including those for carcinoma breast.

Current status of indocyanine green fluorescent angiography in assessing perfusion of gastric conduit and oesophago-gastric anastomosis.

Anastomotic leak (AL) remains a significant complication after esophagectomy. Indocyanine green fluorescent angiography (ICG-FA) is a promising and safe technique for assessing gastric conduit (GC) perfusion intraoperatively. It provides detailed visualization of tissue perfusion and has demonstrated usefulness in oesophageal surgery.

Evaluation of indocyanine green tracheobronchial fluorescence (ICG-TBF) via nebulization during minimally invasive esophagectomy.

Surgical manipulation of the tracheobronchial complex is a contributing factor in pulmonary morbidity of esophagectomy. Accurate dissection between membranous trachea and bronchi with esophagus is essential. This study tests the feasibility of delivering indocyanine green (ICG) in an aerosol form to achieve tracheobronchial fluorescence (ICG-TBF).

Enhanced recovery after surgery in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: national survey of peri-operative practice by Indian society of peritoneal surface malignancies.

Objectives: The Enhanced recovery after surgery (ERAS) program is designed to achieve faster recovery by maintaining pre-operative organ function and reducing stress response following surgery. A two part ERAS guidelines specific for Cytoreductive surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) was recently published with intent of extending the benefit to patients with peritoneal surface malignancies. This survey was performed to examine clinicians' knowledge, practice and obstacles about ERAS implementation in patients undergoing CRS and HIPEC.

Impact of Covid-19 on gastrointestinal cancer surgery: A National Survey.

Purpose: To understand the actual impact of the Covid-19 pandemic and frame the future strategies, we conducted a pan India survey to study the impact on the surgical management of gastrointestinal cancers.

Methods: A national multicentre survey in the form of a questionnaire from 16 tertiary care gastrointestinal oncology centres across India was conducted from January 2019 to June 2021 that was divided into a 15-month pre-Covid era and a similar period of active Covid pandemic era.

Results: There was significant disruption of services; 13 (81%) centres worked as dedicated Covid care centres and 43% reported suspension of essential care for more than 6 months.

Use of Indocyanine Green Fluorescence Imaging in Thoracic and Esophageal Surgery.

Background: Fluorescence imaging using indocyanine green in thoracic and esophageal surgery is gaining popularity because of the potential to facilitate surgical planning, to stage disease, and to reduce postoperative complications. To optimize use of fluorescence imaging in thoracic and esophageal surgery, an expert panel sought to establish a set of recommendations at a consensus meeting.

Methods: The panel included 12 experts in thoracic and upper gastrointestinal surgery from Asia-Pacific countries.

Blumer's Shelf on Laparoscopy.

Blumer's shelf indicates metastatic tumor deposit in rectouterine, or rectovesical pouch on digital rectal or vaginal examination, frequently from stomach, pancreatic, colon, or lung cancer. It underscores the need to carry out  a thorough clinical examination. Though it is much discussed and described in the literature, there are hardly any article or image about its appearance  on laparoscopy.

Thoracic Duct Lymphography by Near-Infrared Indocyanine Green Fluorescence imaging in Thoracic Surgery. A Review.

Near-infrared (NIR) fluorescence imaging with indocyanine green dye (ICG) is an emerging technology in detecting the anatomy of the thoracic duct; hence, it can be useful for the identification of the thoracic duct in real time and prevention of its injury during thoracic surgery. It helps to localize thoracic duct injury, identifying chyle leaks in difficult, recurrent, and refractory cases. This review paper provides insights regarding the current applications, advantages, and potential developments of NIR fluorescence imaging with ICG in recognizing thoracic duct during thoracic surgery.

Laparoscopic Repair of Acute Post-Esophagectomy Diaphragmatic Herniation Following Minimal Access Esophagectomy.

This study's objective was to assess the presentation, incidence, operative approach, and outcomes of acute symptomatic post-esophagectomy diaphragmatic hernia (PEDH), following minimal access esophagectomy (MAE) for esophageal and gastro-esophageal junctional cancer. Between January 2010 and December 2020, all consecutive patients undergoing esophagectomy were retrospectively analyzed. Acute symptomatic PEDH occurred in 4 patients out of 680 consecutive patients undergoing esophagectomy (0.

Impact of COVID-19 on cancer care in India: a cohort study.

Background: The COVID-19 pandemic has disrupted health-care systems, leading to concerns about its subsequent impact on non-COVID disease conditions. The diagnosis and management of cancer is time sensitive and is likely to be substantially affected by these disruptions. We aimed to assess the impact of the COVID-19 pandemic on cancer care in India.

Fluorescence-guided cancer surgery-A new paradigm.

Fluorescence-guided surgery is an emerging and promising operative adjunct to assist the surgeon in various aspects of oncosurgery, ranging from assessing perfusion, identification, and characterization of tumors and peritoneal metastases, mapping of lymph nodes/leaks, and assistance for fluorescence-guided surgery (FGS). This study aims to provide an overview of principles, currently available dyes, platforms, and surgical applications and summarizes the available literature on the utility of FGS with a focus on abdomino-thoracic malignancies.

Minimal Invasive Esophagectomy-a New Dawn of EsophagealSurgery.

Surgery is the mainstay of esophageal cancer. However, esophagectomy is a major surgical trauma on a patient with high morbidity and mortality. The intent of minimally invasive esophagectomy (MIE) is to decrease the degree of surgical trauma and perioperative morbidity associated with open surgery, and provide faster recovery and shorter hospital stay with the equivalent oncological outcome.

The Utility of Indocyanine Green Angiography in the Assessment of Perfusion of Gastric Conduit and Proximal Esophageal Stump Against Visual Assessment in Patients Undergoing Esophagectomy: a Prospective Study.

Post esophagectomy anastomotic leakage is a crucial factor in determining morbidity and mortality. Good vascularity of the gastric conduit is essential to avoid this complication. This prospective study compares the utility of intraoperative indocyanine green (ICG) fluorescence angiography and visual assessment in assessing the vascularity of gastric conduit and proximal esophageal stump in patients undergoing esophagectomy.

Flickering diaphragm sign, an indicator of laparoscopy-associated pneumothorax secondary to pleural breach.

During laparoscopic mobilisation of the oesophagus around hiatus in transhiatal oesophagectomy; commonly the pleura is breached causing iatrogenic pneumothorax. Often small breaches in pleura goes unnoticed till the attention is drawn by anaesthetist when pressures drop with building up of end-tidal CO(etCO2) and other haemodynamic changes occur. We describe the flickering movements of the diaphragm associated with the pleural breach, a useful sign to alert the surgeon and anaesthetist to detect pneumothorax earlier than it is clinically evident.

Uterine Sarcomas: Experience from a Tertiary Cancer Care Center from India.

Uterine sarcomas are uncommon and aggressive tumors comprising 3-7% of all uterine malignancies. The aim is to evaluate clinical presentation, histopathologic pattern, recurrence pattern, and outcome of patients with uterine sarcomas presenting to a tertiary care cancer center over an 8-year period. A total of 11 cases of uterine sarcoma were diagnosed.

Anorectal Malignant Melanoma-Defining the Optimal Surgical Treatment and Prognostic Factors.

Patients with anorectal malignant melanoma (ARMM) have a poor prognosis. Optimal surgical treatment is not defined. The aim of the study was to define the surgical treatment for ARMM, to compare the overall survival (OS) of abdomino-perineal resection (APR) and wide local excision (WLE) and to study various prognostic factors.